| NPI | 1790989861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301089826) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60173904) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2013-08-21 |